Type1diabetes
Conditions
Keywords
Menstrual cycle, Continuous glucose monitoring, Insulin dose, Physical activity, Food intake
Brief summary
In clinical practice, women living with type 1 diabetes frequently report that insulin requirements change across the menstrual cycle. Consequently, glycemic fluctuations are observed. This phenomenon could be explained by a decrease in insulin sensitivity during the second half of the menstrual cycle (luteal phase). Overall, despite an important proportion of women reporting glycemic and/or insulin variations across the menstrual cycle, studies to date have involved small sample sizes, and have had inconsistent results. The objective of this study will be to study glycemic fluctuations across the menstrual cycle using CGM data, alongside insulin data, in a large sample of women.
Interventions
DEVICEContinuous glucose monitoring
Glucose levels will be measured using continuous glucose monitoring
DRUGInsulin
Insulin doses will be retrieved from insulin pump reports (for insulin pump users) or journals for (for multiple daily injections users)
OTHERPremenstrual symptoms
Premenstrual symptoms will be assessed using the Premenstrual symptoms screening tool
OTHEROvulation kits
Ovulation testing will be done using ovulation kits
DEVICEFitbit Inspire 2
Physical activity will be assessed using the Fitbit Inspire 2
OTHERKeenoa
Food intake will be assessed using the Keenoa phone application
OTHERMenstrual cycle
The application My Calendar will be used to record information on the menstrual cycle
Sponsors
Institut de Recherches Cliniques de Montreal
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
1. Females aged 18 to 50 living in Canada. 2. Clinical diagnosis of type 1 diabetes or latent autoimmune diabetes in adults (LADA) for at least one year. 3. Using insulin pump therapy, multiple daily injections or automated insulin delivery systems for at least 3 months. 4. Using a continuous glucose monitoring (CGM) system. 5. Having at least one menses in the last 40 days. 6. Accepting to share CGM data with the research team and if applicable insulin pump data.This access will be limited to the study period. 7. Having a smartphone or tablet to follow menstrual cycles. 8. Stable weight (less than 5% variation in the last 3 months).
Exclusion criteria
1. Using a hormonal contraception method that eliminates menses (Depo Provera, progestin intrauterine device, extented-cycle regimen with birth control pill) 2. Using regular insulin (Entuzity U500, Novolin ge Toronto or Humulin R). 3. Clinically significant nephropathy (eGFR \< 30 ml/min/1.73m2, planned or on dialysis) or neuropathy (e.g., known uncontrolled gastroparesis) as judged by the investigator. 4. Recent (\< 6 months) acute macrovascular event (e.g., acute coronary syndrome or cardiac surgery). 5. Anticipated therapeutic change (including change of insulin type and/or type of CGM sensor, insulin pump or AID (automated insulin device) system) between admission and end of the study. 6. Anticipated change in contraception method or plan to begin or stop a contraceptive method. 7. Anticipated need to use acetaminophen during the study period at a dose above 1g every 6 hours. 8. Pregnancy (ongoing or current attempt to become pregnant) 9. Breastfeeding 10. Uncontrolled thyroid disease (TSH should be in target range and treatment stable for at least 6 weeks). 11. Severe hypoglycemic episode within two weeks of screening 12. Severe hyperglycemic episodes requiring hospitalization in the last 3 months. 13. Current use of glucocorticoid medication (except low stable dose and inhaled steroids and stable adrenal insufficiency treatment e.g., Cortef®) 14. Agents affecting gastric emptying (Motilium®, Victoza®, Ozempic®, Trulicity®, Byetta® and Symlin®) as well as oral anti-diabetic agents (Metformin, Prandase®, DPP-4 inhibitors) unless at a stable dose for 3 months and without anticipated change during the study. 15. Current use of SGLT-2 inhibitors unless at a stable dose for at least 3 months, without anticipated change during the study and appropriate ketone testing is performed. 16. Other serious medical illnesses which likely interfere with study participation or with the ability to complete the study by the judgment of the investigator. 17. Anticipation of a significant change in exercise or diet regimen between admission and end of the study (i.e., starting or stopping an organized sport; planned significant diet change). 18. Anticipated radiologic examination incompatible with CGM wear for more than 10 days between admission and end of the study (e.g., repeated MRI). 19. In the opinion of the investigator, a participant who is unable or unwilling to complete the study. 20. If taking medication for hypothyroidism, no change of dose (Levothyroxin) in the last 6 weeks.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Mean glucose levels during the early follicular phase | Day 1 to 5 of the menstrual cycle |
| Mean glucose levels during the mid-late follicular phase | Day 6 until 2 days prior to ovulation |
| Mean glucose levels during the periovulation phase | Ovulation plus/minus 1 day |
| Mean glucose levels during the early luteal phase | Day 2 to 4 after ovulation |
| Mean glucose levels during the mid-luteal phase | Day 5 to 9 after ovulation |
| Mean glucose levels during the late luteal phase | Day 10 after ovulation until the first day of the next menstrual cycle |
Secondary
| Measure | Time frame |
|---|---|
| Percentage of time of glucose levels between 3.9 and 7.8 mmol/L | Day 1 to 5 of the menstrual cycle |
| Percentage of time of glucose levels between 3.9 and 10.0 mmol/L | Day 1 to 5 of the menstrual cycle |
| Percentage of time of glucose levels below 3.9 mmol/L | Day 1 to 5 of the menstrual cycle |
| Percentage of time of glucose levels below 3.0 mmol/L | Day 1 to 5 of the menstrual cycle |
| Percentage of time of glucose levels above 10.0 mmol/L | Day 1 to 5 of the menstrual cycle |
| Percentage of time of glucose levels above 13.9 mmol/L | Day 1 to 5 of the menstrual cycle |
| Standard deviation of glucose levels | Day 1 to 5 of the menstrual cycle |
| Coefficient of variance of glucose levels | Day 1 to 5 of the menstrual cycle |
| Low blood glucose index | Day 1 to 5 of the menstrual cycle |
| High blood glucose index | Day 1 to 5 of the menstrual cycle |
| Standard deviation of insulin delivery | Day 1 to 5 of the menstrual cycle |
| Coefficient of variance of insulin delivery | Day 1 to 5 of the menstrual cycle |
| Total insulin delivery | Day 1 to 5 of the menstrual cycle |
Countries
Canada
Contacts
CONTACTAnne Bonhoure
PRINCIPAL_INVESTIGATORRémi Rabasa-Lhoret
Institut de recherches cliniques de Montréal
Outcome results
None listed